The United Nations Children's Fund (UNICEF) has supported Egypt's Ministry of Health and Population (MOHP) in undertaking a variety of communication activities to eradicate polio in this country, including National Immunisation Days (NIDs) and other social mobilisation activities. Developed to maximise NID coverage, this communication plan reaches out to all caregivers in Egypt, but focuses particularly on: those living in high-risk areas in Greater Cairo, Menya, and Assuit; those of a higher socio-economic status (SES) in urban areas; and underprivileged groups. Secondary groups addressed included media personnel at the national level, as well as community and religious leaders. The purpose of this effort is to contribute to the eradication of polio in Egypt (achieved on February 1 2006) by developing levels of public awareness of the NID campaigns at above 95% and by motivating the public to vaccinate their children against polio.

Communication Strategies:

This programme follows up on, and was developed in response to, previous years' NIDs - which found television to be a key medium for disseminating polio messages. However, while continuing to draw on this medium, the MOHP worked to develop approaches to prevent public fatigue and boredom that might have been caused by repeating the same discussion on the issue. Geographically, MOHP opted to continue focusing on the urban areas of Greater Cairo, Menya, and Assuit, which pose a great challenge in reaching 100% coverage due to density and overcrowding.

Building on some of these existing opportunities to give polio wider public visibility has been the programme's key approach. Key communication for development (C4D) strategies have included: advocacy, use of mass media, mobilisation of youth, and the institutional support provided to the Ministry of Health on social mobilisation planning and practice. All C4D activities contributed to the goal of mobilising the national society in support of the NID campaigns.

Advocacy: The campaigns received the political support of the First Lady of Egypt, and most campaigns were locally launched by the designated governors.

Mass Media:

TV spots were produced and aired as many as 650 times on local channels as well as popular satellite channels.

In one year, approximately 20 TV and radio programmes on polio were produced and aired before and during the NID campaigns.

More than 70 press articles were published in one year.

Outdoor advertising was used.

Mobile phone text messaging was used.

Celebrity Involvement:

Goodwill Ambassador Mahmoud Kabil (leading Egyptian film and television actor) volunteered his time in an integrated media awareness campaign that included:

an education TV spot capitalising on the credibility of Mr. Kabil in speaking to the public, particularly those in the upper SES (who constitute a greater opposing group to immunisations in urban areas)

a 5-second-long "count-down" public service announcement (PSA) that is aired prior to each NID campaign

use of existing TV and radio spots and a celebrity song produced in 2002

a wide-reaching short messaging service (SMS) campaign in cooperation with Mobinil

initiation of media coverage of polio through in-depth reports by senior writers of key newspapers and magazines

cooperation with existing TV and radio programmes to include polio

using the Radio "Nile FM" channel to reach younger caregivers.

Some of the specific messages that Kabil conveyed in interviews and other media included:

All children of Egypt must be immunised at the same time during the NID in order to be able to eradicate polio completely from Egypt

Immunise all children from day one to 5 years

All children must be immunised even if they have been previously immunised, have completed their vaccination schedule, or are being followed by a private paediatrician

Vaccine quality is guaranteed; vaccination has no side effects

There is no maximum number of polio doses

Vaccination teams are well trained.

Exercising a multi-pronged approach, UNICEF also involved pop stars including Mohamed Mounir, who released a song about the fight for children's health, and against polio. Television and radio spots raised awareness both on NIDs and sub-national NIDs (SNIDs), and on the critical importance of involvement by families. Religious leaders spoke out in mosques and churches on the critical importance of vaccination, and an announcement was issued by Grand Shiekh of Al-Azhar helping in the establishment of trust and encouraging people to open their doors to the vaccinators.

Information, education, and communication (IEC) materials: The printing of supportive materials in one year included: 15,000 Arabic/English Fact Sheets, 165,000 posters for clinics, 65,000 vaccination team ID cards, 300,000 registry books, and 30 million stickers for house marking.

Community Participation: Evaluation of past efforts also found that megaphones and mobile trucks play an important role in reinforcing the vaccination messages on the community level, as do awareness activities in crowded areas (markets and bus stations) led by volunteers who are recruited by non-governmental organisations (NGOs). To maximise reach in urban slums, the youth volunteers of the Youth Association for Population and Development conducted door-to-door awareness campaigns in these areas. These strategies are designed to ensure full coverage of high-risk areas while engaging other stakeholders like youth centres, schools, religious leaders, and community organisations. In cooperation with the local health authorities in each of the areas being addressed, MOHP and the Youth Association for Population and Development also re-printed a simple question-and-answer (Q&A) brochure for caregivers to be distributed by NGO volunteers and others. A special advocacy meeting was also set up for religious leaders (both Muslim and Christian) representing high-risk areas.

Interpersonal training has been another key programme component. 50,000 teams of vaccinators were formed, each consisting of 2 vaccinators and a supervisor. In addition, intensive capacity-building of the MOHP District Managers on social mobilisation planning led to the inclusion of standard social mobilisation components within most of the microplans being carried out in Egypt's high-risk areas. Volunteers were deployed to reach out to people. Immediate supervisors and health educators within the Ministry also received communications skills training to improve their capacities to address the day-to-day issues that arise due to resistance or refusals.

Partnership - particularly with the private sector - has supported several of this programme's social mobilisation activities. Egypt's leading mobile phone company donated over a 5 million SMS messages to all its subscribers. Coca Cola Company's billboards and trucks were branded with polio messages.

April 2013 update:
Active surveillance measures in Egypt have detected environmental polio virus for the second time in two years. Accordingly, the Ministry of Health and Population in collaboration with UNICEF and WHO launched a sub-national immunisation campaign which will be followed by NIDs. Comprehensive communication and social mobilisation campaigns that encourage caregivers to vaccinate their children under the age of 5 years are integral parts of such campaigns. In addition to usual mass media channels, outdoor signage, and print material, social media and other social marketing approaches have been used to reach out to caregivers, with a special focus on reaching the most disadvantaged populations. Among those ideas used in the March 3-13 2013 communication campaign implemented in Greater Cairo is the branded tok tok (pictured above). This small vehicle branded with the campaign image roams the urban slum areas of Cairo to announce the immunisation dates and locations and promote the campaign messages through an edutainment song especially written for this occasion. Trained campaign promoters answering people's queries and guiding them to vaccination teams were also part of this initiative. In addition, a public service announcement (PSA) may be viewed below.

Development Issues:

Immunisation & Vaccines.

Key Points:

In 2002, UNICEF was called upon by the Technical Advisory Group (TAG) to support MOHP in conducting social mobilisation and communication activities to complement the door-to-door "challenge" strategy that was the MOHP's focus. A diverse group of stakeholders including government, NGOs, media, and the private sector were approached to create awareness and to mobilise individuals to achieve maximum coverage. This mass media campaign, coupled with community interventions, reached up to 99% of a random sample of people who had heard of the 2002 and 2003 NIDs. The campaign was found to have motivated 58% through TV spots, 83% through TV programmes, and 86% through a celebrity song; approximately 86% said the megaphones motivated them to immunise their children. Most of the Egyptian children were covered during the 2002 and 2003 NIDs, but one confirmed polio case was reported in 2004. A survey of missed children was conducted to identify the profile of the missed children; it showed that a large percentage are missed between the ages of 4 to 5 years and under one year of age. These children tend to have non-working mothers who have some education and who on the third quintile of the wealth index.

While in 2002, almost 11% of Egyptians surveyed by UNICEF believed polio vaccine could have harmful effects, by 2005, 98% fully trusted it.

Egypt was declared polio-free on February 1 2006. However, efforts have not ceased, particularly in the area of surveillance, said UNICEF Egypt Health Officer Dr. Essam Allam: "Awareness campaigns on the primal importance of immunisation are still being conducted, particularly in the most vulnerable areas..."

Partner Text:

MOHP, World Health Organization (WHO), UNICEF, the United States Agency for International Development (USAID), Rotary International, Government of Japan, Centers for Disease Control and Prevention (CDC), General NGO Federation, Youth Association for Population and Development, Scouts, Red Crescent, Mobinil, Coca Cola, and the Egyptian Radio and TV Union.

"Support to National POLIO Social Mobilization: Plan of Activities for 2004" by UNICEF and the Egyptian Ministry of Health (EMOH) - March 2004; email from Sahar Hegazi to The Communication Initiative on September 27 2010, which included: 1) "Celebrating Victory: The Story of How Egypt Defeated the Polio Virus, Once and for All", by Serene Assir, UNICEF Egypt Cairo, May 15 2008; and 2) "Communication for Development (C4D) in the UNICEF-Assisted National Immunization Day (NID) Campaigns of Egypt's Polio Eradication Program, A Case of Good Practice"; and "Egypt Is and Shall Remain Polio-Free", by Samar Ibrahim, Global Immunization News, March 31 2013.

Comments

I wish all health professionals and officials in immunization program see how communication work can bring meaningful impact in polio eradication in the world. Congradulation to Sarah and UNICEF Egypt.

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